epi monthly report - florida department of...

EPI Monthly Report

Florida Department of Health in Miami-Dade County

MIAMIDADE.FLORIDA.HEALTH.GOV

Epidemiology,

Disease Control &

Immunization

Services

8600 NW 17th Street

Suite 200

Miami, Florida 33126

Tel: (305) 470-5660

Fax: (305) 470-5533

Volume 17 Issue 1 January 2016 1

Epidemiology of Animal Bites and Administration of Post-Exposure Prophylaxis (PEP) in

Miami-Dade County, Florida, 2014 Isabel Griffin, MPH. Danielle Fernandez, MPH. Guoyan Zhang, MD, MPH.

Inside this

Month’s Issue

1 Epidemiology of

Animal Bites and

Administration of

Post Exposure

Prophylaxis (PEP) in

Miami-Dade County,

FL, 2014

4 Zika Virus:

Identifying an

Emerging Threat

5 EDC-IS Influenza/

Respiratory Illness

Surveillance Report

6 Selected Reportable

Diseases/

Conditions in

December 2015

BACKGROUND

It starts with flu-like symptoms, quickly

progressing within days to feelings of

anxiety, confusion, and agitation. Once

you are symptomatic—survival is rare.

Rabies is one of the few viruses in the

world that can cause 100% fatal illness in

humans if left untreated, but it is also

preventable. The rabies virus can be

transmitted through contact with infected

saliva and nervous system tissue by both

domestic and wild mammals. In the state

of Florida, the most frequently reported

rabid domestic mammals are outdoor

cats, while raccoons and bats are the

most common wildlife sources of rabies

(1). For this reason, domesticated dogs

and cats are required by law to be

vaccinated against rabies in the state of

Florida, this requirement also protects

household animals from wildlife

exposures to rabies (1).

Every year, there are approximately

2,000 animal bites/exposure cases

reported to the Florida Department of

Health in Miami-Dade County (DOH-

Miami-Dade). Due to the potential for

transmission of rabies, DOH-Miami-

Dade promptly investigates all reports of

possible rabies exposure and provides

recommendations regarding post-

exposure prophylaxis (PEP) to animal

bite clients. This study aimed to address

the epidemiology of animal bites in

Miami-Dade County in 2014.

METHODS

Reported animal bites/exposure cases in

2014 among Miami-Dade County

residents were obtained from Merlin, the

Florida Department of Health

Epidemiology Surveillance System. SAS

9.3 and ArcGIS were used for data

analysis and hot spot identification (2, 3).

RESULTS

In 2014, DOH-Miami-Dade received

reports of 2,018 animal bites/exposures.

The median age of those who reported

animal bites/exposures was 21.5 (range 0

to 100). Females accounted for 52.2%

animal bite cases. Fifty-four percent of

animal bite cases were Hispanic, 19.8%

were Non-Hispanic White, and 15.1%

were Non-Hispanic Black. When race/

ethnicity was stratified by gender,

Hispanic females, Non-Hispanic White

females, and Non-Hispanic Black males

reported animal bite/exposure most

frequently.

Two hot spots were identified in high

density population areas in the northern

and central regions of the county for both

reports of dog and cat bites (Figure 1).

Dogs accounted for the majority of

events (81.2%) followed by cats (11.8%)

and other animals, such as, raccoons,

monkeys, rats, and bats (1%). Bites/

exposures occurred predominantly on the

hand (41.9%), leg (23.1%), arm (14.0%)

and head (8.5%). There were no

significant differences among age group

and bite location. There was no obvious

pattern of seasonality found; however,

EPI Monthly Report




this was expected given that the climate in Miami is relatively consistent throughout the

year.

Figure 1: Density Analysis of Dog and Cat Bites in Miami-Dade County, Florida, 2014

Continued on page 3...

EPI Monthly Report




Ninety-four percent of reported exposures

visited an emergency department. Eleven

percent of individuals with reported exposures

were recommended PEP treatment by public

health or medical practitioners. These

recommendations were made based on the

level of risk associated with the animal bite:

location of the animal bite, whether the animal

was provoked, and whether the animal had

been vaccinated. Of the 222 PEP-

recommended cases, 69.8% of those actually

received PEP and 30.2% had unknown PEP

status. Administration of PEP to individuals

ranged from the same day of exposure to a

maximum of 2 days post-exposure.

PREVENTION

Miami-Dade County residents can take actions

to prevent animal bites by avoiding direct con-

tact with wildlife and by vaccinating their house-

hold pets. Residents should also promptly seek

medical care after being bit by an animal in order

to be evaluated for post-exposure prophylaxis (4).

REFERENCES

"Rabies." Rabies. Florida Department of

Health, n.d. Web. 21 Jan. 2016. Retrieved

from http://www.floridahealth.gov/diseases

-and-conditions/rabies/index.html

SAS 9.3. Cary, NC: SAS Institute.

ArcGIS Desktop: Release 10. Redlands, CA:

Environmental Systems Research Institute.

"What Care Will I Receive?" Centers for Dis-

ease Control and Prevention. Centers for

Disease Control and Prevention, 21 Sept.

2015. Web. 21 Jan. 2016. Retrieved from

http://www.cdc.gov/rabies/medical_care/

index.html

http://www.floridahealth.gov/diseases-and-conditions/rabies/index.html

http://www.floridahealth.gov/diseases-and-conditions/rabies/index.html

http://www.cdc.gov/rabies/medical_care/index.html

http://www.cdc.gov/rabies/medical_care/index.html

EPI Monthly Report




Zika Virus: Identifying an Emerging Threat by Michael Delgado

Transmission:

Zika virus is a flavivirus related to Dengue and West

Nile viruses that is transmitted to humans through the

bite of the Aedes mosquito. In addition to mosquito-to-

human transmission, Zika virus infections have been

documented through intrauterine, intrapartum, sexual,

and blood transmission. It is possible that Zika virus

could be transmitted through organ transplants and

breastfeeding, but neither of these pathways of infection

have been reported.

Although local transmission of Zika virus has not been

documented in the continental United States, Zika virus

infections have been reported in returning travelers. In

light of the recent outbreaks of Zika in the Americas, the

Pacific Islands, Africa, and Southeast Asia, the number

of Zika virus disease cases among travelers visiting or

returning to the United States is likely to increase. These

imported cases might result in local human-to-mosquito-

to-human spread of the virus in limited areas of the

continental United States that have the appropriate

mosquito vectors. In January 2016, the Florida

Department of Health confirmed that two people in

Miami-Dade County contracted the Zika virus while

visiting South America.

Pathology:

During outbreaks, humans are the primary amplifying

host for Zika virus. Approximately 80% of Zika virus

cases are asymptomatic. In symptomatic cases, the

symptoms appear after an incubation period of 3-12 days

following the infected mosquito bite. Symptoms are

usually mild and the most common symptoms are fever,

maculopapular rash, joint pain, and conjunctivitis

(pinkeye). Symptoms last between a few days and a

week. Guillain-Barré syndrome has been reported in

patients during an outbreak in French Polyensia

following suspected Zika virus infection. Recent

research suggests that the newborns of mothers who had

a Zika virus infection (asymptomatic or symptomatic)

during their first trimester are at a significantly increased

risk of microcephaly. The Brazilian Ministry of Health

has reported a marked increase in the number of

infants born with microcephaly in 2015, although it

is not known how many of these cases are associated

with Zika virus infection.

Diagnosis:

Zika virus infection should be considered in patients

with acute onset of fever, maculopapular rash, join

pain, or conjunctivitis, who traveled to areas with

ongoing outbreaks in the two weeks prior to the

onset of the symptoms. Fetuses and infants of

women infected with Zika virus during pregnancy

should be evaluated for possible congenital

infection.

Reporting:

In 2016, Zika virus disease became a nationally

notifiable condition. Health care providers are

encouraged to report suspected cases to their state or

local health departments to facilitate diagnosis and

mitigate the risk of local transmission. Cases of Zika

fever should be reported to the Miami-Dade County

Department of Health as “arboviral diseases not

otherwise listed” in the Practitioner Disease Report

Form.

Prevention:

One way to prevent infection with Zika virus is to

avoid travelling to areas in which there are currently

ongoing outbreaks. The CDC has issued a Level 2

travel alert for regions and certain countries where

Zika virus transmission remains ongoing. Pregnant

women (in any trimester) should consider cancelling

travel plans to areas where Zika virus transmission is

currently happening. Women who are trying to

become pregnant should consult their health care

provider before travelling to these areas. Another

way to prevent infection with Zika virus is to avoid

mosquito bites. Recommendations on how to avoid

mosquito bites can be found at http://www.cdc.gov/

ncezid/dvbd/

EPI Monthly Report




TO REPORT ANY DISEASE AND FOR INFORMATION CALL:

Epidemiology, Disease Control & Immunization Services

Childhood Lead Poisoning

Prevention Program ………...……………305-470-6877 Hepatitis ……………………………………...305-470-5536 Immunizations or outbreaks ………....305-470-5660 HIV/AIDS Program ………………….……….305-470-6999

STD Program ……………………….………...305-575-5430 Tuberculosis Program …………………….305- 575-5415

Immunization Service …………..…………305-470-5660

To make an appointment………………...786-845-0550

PARTICIPATE IN INFLUENZA SENTINEL PROVIDER SURVEILLANCE

Florida Department of Health in Miami-Dade County NEEDS Influenza Sentinel Providers!

Sentinel providers are key to the success of the Florida Department of Health’s Influenza Surveillance System. Data reported by sentinel providers gives a picture of the influenza virus and ILI activity in the U.S. and Florida which can be used to guide prevention and control activities, vaccine strain selection, and patient care.

Providers of any specialty, in any type of practice, are eligible to be sentinel providers.

Most providers report that it takes less than 30 minutes a week to compile and report data on the total number of patients seen and the number of patients seen with influenza-like illness.

Sentinel providers can submit specimens from a subset of patients to the state laboratory for virus isolation free of charge.

For more information, please contact

Lakisha Thomas at 305-470-5660.

About the Epi Monthly Report

The Epi Monthly Report is a publication of the Florida Department of Health in Miami-Dade County:

Epidemiology, Disease Control & Immunization Services. The publication serves a primary audience of

physicians, nurses, and public health professionals. Articles published in the Epi Monthly Report may focus

on quantitative research and analysis, program updates, field investigations, or provider education. For

more information or to submit an article, please contact Emily Moore at (305) 470-6918.

EPI Monthly Report




2015 2015 2014 2013

Current Month Year to Date Year to Date Year to Date

HIV/AIDS

AIDS* 46 482 523 671

HIV 120 1426 1217 1264

STDInfectious Syphilis* 22 325 329 364

Chlamydia* 1062 10768 9655 9753

Gonorrhea* 246 2221 2137 2285

TBTuberculosis** 16 125 128 135

Epidemiology, Disease Control &

Immunization Services

Epidemiology

Campylobacteriosis 19 353 348 353

Chikungunya Fever 2 28 82 0

Ciguatera Poisoning 0 15 24 27

Cryptosporidiosis 4 49 38 20

Cyclosporiasis 1 4 4 3

Dengue Fever 8 35 40 45

Escherichia coli, Shiga Toxin-Producing 2 8 27 11

Encephalitis, West Nile Virus 0 0 0 0

Giardiasis, Acute 17 200 220 268

Influenza Novel Strain 0 0 0 0

Influenza, Pediatric Death 2 2 1 1

Legionellosis 7 32 19 26

Leptospirosis 0 1 0 0

Listeriosis 0 6 5 3

Lyme disease 1 11 14 6

Malaria 1 8 7 9

Meningitis (except aseptic) 3 10 29 33

Meningococcal Disease 0 6 12 16

Salmonella serotype Typhy (Typhoid Fever) 0 2 1 3

Salmonellosis 89 729 651 591

Shigellosis 6 144 647 93

Streptococcus pneumoniae, Drug Resistant 1 2 45 85

Vibriosis 3 20 16 15

West Nile Fever 0 0 0 0

Immunization Preventable Diseases

Measles 0 0 0 0

Mumps 0 3 0 0

Pertussis 6 35 36 42

Rubella 0 0 0 0

Tetanus 0 0 0 0

Varicella 7 0 0 0

Hepatitis

Hepatitis A 4 37 35 32

Hepatitis B (Acute) 2 13 11 20

Lead

Lead Poisoning 6 86 79 91

*Data is provisional at the county level and is subject to edit checks by state and federal agencies.

** Data on tuberculosis are provisional at the county level.

Diseases/Conditions

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